Multimedia

Life expectancy for the nation as a whole has increased, the researchers said, but affluent people have experienced greater gains, and this, in turn, has caused a widening gap.

One of the researchers, Gopal K. Singh, a demographer at the Department of Health and Human Services, said “the growing inequalities in life expectancy” mirrored trends in infant mortality and in death from heart disease and certain cancers.

The gaps have been increasing despite efforts by the federal government to reduce them. One of the top goals of “Healthy People 2010,” an official statement of national health objectives issued in 2000, is to “eliminate health disparities among different segments of the population,” including higher- and lower-income groups and people of different racial and ethnic background.

Dr. Singh said last week that federal officials had found “widening socioeconomic inequalities in life expectancy” at birth and at every age level.

He and another researcher, Mohammad Siahpush, a professor at the University of Nebraska Medical Center in Omaha, developed an index to measure social and economic conditions in every county, using census data on education, income, poverty, housing and other factors. Counties were then classified into 10 groups of equal population size.

In 1980-82, Dr. Singh said, people in the most affluent group could expect to live 2.8 years longer than people in the most deprived group (75.8 versus 73 years). By 1998-2000, the difference in life expectancy had increased to 4.5 years (79.2 versus 74.7 years), and it continues to grow, he said.

After 20 years, the lowest socioeconomic group lagged further behind the most affluent, Dr. Singh said, noting that “life expectancy was higher for the most affluent in 1980 than for the most deprived group in 2000.”

“If you look at the extremes in 2000,” Dr. Singh said, “men in the most deprived counties had 10 years’ shorter life expectancy than women in the most affluent counties (71.5 years versus 81.3 years).” The difference between poor black men and affluent white women was more than 14 years (66.9 years vs. 81.1 years).

The Democratic candidates for president, Senators Hillary Rodham Clinton of New York and Barack Obama of Illinois, have championed legislation to reduce such disparities, as have some Republicans, like Senator Thad Cochran of Mississippi.

Peter R. Orszag, director of the Congressional Budget Office, said: “We have heard a lot about growing income inequality. There has been much less attention paid to growing inequality in life expectancy, which is really quite dramatic.”

Life expectancy is the average number of years of life remaining for people who have attained a given age.

While researchers do not agree on an explanation for the widening gap, they have suggested many reasons, including these:

¶Doctors can detect and treat many forms of cancer and heart disease because of advances in medical science and technology. People who are affluent and better educated are more likely to take advantage of these discoveries.

¶Smoking has declined more rapidly among people with greater education and income.

¶Lower-income people are more likely to live in unsafe neighborhoods, to engage in risky or unhealthy behavior and to eat unhealthy food.

¶Lower-income people are less likely to have health insurance, so they are less likely to receive checkups, screenings, diagnostic tests, prescription drugs and other types of care.

Even among people who have insurance, many studies have documented racial disparities.

In a recent report, the Department of Veterans Affairs found that black patients “tend to receive less aggressive medical care than whites” at its hospitals and clinics, in part because doctors provide them with less information and see them as “less appropriate candidates” for some types of surgery.

Some health economists contend that the disparities between rich and poor inevitably widen as doctors make gains in treating the major causes of death.

Nancy Krieger, a professor at the Harvard School of Public Health, rejected that idea. Professor Krieger investigated changes in the rate of premature mortality (dying before the age of 65) and infant death from 1960 to 2002. She found that inequities shrank from 1966 to 1980, but then widened.

“The recent trend of growing disparities in health status is not inevitable,” she said. “From 1966 to 1980, socioeconomic disparities declined in tandem with a decline in mortality rates.”

The creation of Medicaid and Medicare, community health centers, the “war on poverty” and the Civil Rights Act of 1964 all probably contributed to the earlier narrowing of health disparities, Professor Krieger said.

Robert E. Moffit, director of the Center for Health Policy Studies at the conservative Heritage Foundation, said one reason for the growing disparities might be “a very significant gap in health literacy” — what people know about diet, exercise and healthy lifestyles. Middle-class and upper-income people have greater access to the huge amounts of health information on the Internet, Mr. Moffit said.

Thomas P. Miller, a health economist at the American Enterprise Institute, agreed.

“People with more education tend to have a longer time horizon,” Mr. Miller said. “They are more likely to look at the long-term consequences of their health behavior. They are more assertive in seeking out treatments and more likely to adhere to treatment advice from physicians.”

A recent study by Ellen R. Meara, a health economist at Harvard Medical School, found that in the 1980s and 1990s, “virtually all gains in life expectancy occurred among highly educated groups.”

Trends in smoking explain a large part of the widening gap, she said in an article this month in the journal Health Affairs.

Under federal law, officials must publish an annual report tracking health disparities. In the fifth annual report, issued this month, the Bush administration said, “Over all, disparities in quality and access for minority groups and poor populations have not been reduced” since the first report, in 2003.

The rate of new AIDS cases is still 10 times as high among blacks as among whites, it said, and the proportion of black children hospitalized for asthma is almost four times the rate for white children.

The Centers for Disease Control and Prevention reported last month that heart attack survivors with higher levels of education and income were much more likely to receive cardiac rehabilitation care, which lowers the risk of future heart problems. Likewise, it said, the odds of receiving tests for colon cancer increase with a person’s education and income.

Sex Infections Found in Quarter of Teenage Girls

The first national study of four common sexually transmitted diseases among girls and young women has found that one in four are infected with at least one of the diseases, federal health officials reported Tuesday.

The 50 percent figure compared with 20 percent of white teenagers, health officials and researchers said at a news conference at a scientific meeting in Chicago.

The two most common sexually transmitted diseases, or S.T.D.’s, among all the participants tested were HPV, at 18 percent, and chlamydia, at 4 percent, according to the analysis, part of the National Health and Nutrition Examination Survey.

Each disease can be serious in its own way. HPV, for example, can cause cancer and genital warts.生殖器溼疣

Among the infected women, 15 percent had more than one of the diseases.

Officials of the Centers for Disease Control and Prevention said the findings underscored the need to strengthen screening, vaccination and other prevention measures for the diseases, which are among the highest public health priorities.

About 19 million new sexually transmitted infections occur each year among all age groups in the United States.

“High S.T.D. infection rates among young women, particularly young African-American women, are clear signs that we must continue developing ways to reach those most at risk,” said Dr. John M. Douglas Jr., who directs the centers’ division of S.T.D. prevention.

The president of the Planned Parenthood Federation of America, Cecile Richards, said the new findings “emphasize the need for real comprehensive sex education.”

Although earlier annual surveys have tested for a single sexually transmitted disease in a specified population, this is the first time the national study has collected data on all the most common sexual diseases in adolescent women at the same time. It is also the first time the study measured human papillomavirus.

Dr. Douglas said that because the new survey was based on direct testing, it was more reliable than analyses derived from data that doctors and clinics sent to the diseases center through state and local health departments.

“What we found is alarming,” said Dr. Sara Forhan, a researcher at the centers and the lead author of the study.

“Far too many young women are at risk for the serious health effects of untreated S.T.D.’s, ” she said.

The centers conducts the annual study, which asks a representative sample of the household population a wide range of health questions. The analysis was based on information collected in the 2003-4 survey.

Extrapolating from the findings, Dr. Forhan said 3.2 million teenage women were infected with at least one of the four diseases.

The 838 participants in the study were chosen at random with standard statistical techniques. Of the women asked, 96 percent agreed to submit vaginal swabs for testing.

The findings and specific treatment recommendations were available to the participants calling a password-protected telephone line. Three reminders were sent to participants who did not call.

Health officials recommend treatment for all sex partners of individuals diagnosed with curable sexually transmitted diseases. One promising approach to reach that goal is for doctors who treat infected women to provide or prescribe the same treatment for their partners, Dr. Douglas said. The goal is to encourage men who may not have a physician or who have no symptoms and may be reluctant to seek care to be treated without a doctor’s visit.

He also urged infected women to be retested three months after treatment to detect possible reinfection and to treat it.

Dr. Forhan said she did not know how many participants received their test results.

2008年3月10日 星期一

A Touch of Grace: Massage Therapy Aids Retired Nuns

BRONX, N.Y. -- Here at the Providence Rest nursing home, which caters mostly to retired nuns and devout Roman Catholics, Harold Packman has developed an important expertise: Giving massages to women who may have spent a lifetime shying away from this kind of physical contact.

Women like Sister Mary Austin Cantwell. Recently, Sister Cantwell, 67 years old and wearing some traditional vestments, rolled in on her motorized scooter for an appointment. Mr. Packman gingerly lifted the hem of the nun's black skirt and started rubbing her arthritic knee.

"Oh, this is heaven," Sister Cantwell exclaimed as he applied cream to her afflicted joint. "I am in heaven."

Sister Cantwell is a bit of an exception: She lets Mr. Packman make contact directly with her knee without any intervening garment. Many other patients are more vigilant, arriving in long dresses, support hose, and bulky long-sleeved sweaters that are not to be disturbed.

hosieryShow phoneticsnoun[U] (ALSOhose) FORMALa word used especially in shops for items such as socks, tights and stockings:Women's hosiery you'll find on the second floor, Madam.

Providence Rest hired Mr. Packman, a licensed massage therapist, as part of an unusual experiment to cut its use of antipsychotic drugs. These controversial drugs -- which are often used as "chemical restraints" to sedate agitated patients -- have set off a national debate over whether nursing homes are misusing them. Newer versions, known as "atypical" antipsychotics, can increase the risk of death in elderly people with Alzheimer's disease, the Food and Drug Administration has warned.

Providence Rest's alternative treatments sound like something from a pricey spa, not a nursing home in the Bronx. Instead of antipsychotics, it has developed regimens involving aromatherapy, long, soothing bubble baths, use of medicines thought to have fewer, less severe side-effects -- and Mr. Packman's rubdowns.

Startling Results

The results are startling. Nationwide, some 30% of nursing-home patients are put on antipsychotics, according to federal data, but Providence Rest has cut its own use down to 2% or 3%. That's the lowest rate of any nursing home in New York, and among the lowest in the country, according to the New York Association of Homes & Services for the Aging.

"Harold is a very big factor" in that success, says Jocelyn Ronquillo, Providence Rest's medical director and leader of its anti-antipsychotics drive. When she arrived at the home, usage of antipsychotic drugs was at 22% to 23%, Dr. Ronquillo says.

Mr. Packman's strongest weapon in persuading clients to acquiesce to his touch may be the fact that he's as old as -- or older than -- most of the women he treats. "There are advantages to looking like I do," says Mr. Packman, who is 85, although with his sprightly gait and shock of white hair doesn't look a day over 80.

"Patients say, 'You have no idea how much pain I have,' and I say, 'Oh yes I do.' "

Providence Rest, which is run by an order of nuns, mainly cares for lay Italian Catholic women and some retired sisters, though there are a few males and non-Christians. All residents have crucifixes in their rooms. Many hail from the old country.

Patients arrive for their massages in wheelchairs and never disrobe or even lie down. At the most, some might merely let him lift up a trouser leg.

No matter. Mr. Packman, who has been a massage therapist for nearly a half-century, insists he can get the job done while respecting the boundaries. To put patients at ease, he banters like a borscht-belt tummler, delivering a stream of corny old jokes.

"What is such a rotten joint doing in a nice kid like you?" he says to Sister Cantwell's knee. She chuckles, even though she's heard that one before -- at her last massage.

Back when Providence Rest went looking for a massage therapist with a specialty in geriatrics, Mr. Packman was the only one it could find. He joined in 2002 as the home began testing its alternative approach to managing patient pain and agitation. Among other things, Providence Rest substitutes antidepressants and Alzheimer's drugs for antipsychotics, believing them to have fewer, less-drastic side-effects.

On a typical day Mr. Packman, who works part time, might see as many as 12 to 15 patients.

"Rosa, buon giorno," he calls out as Rosa Rizzo, 93, arrives bundled up in a flowing dress and a woolen sweater that she won't remove. In fact, she won't let him so much as roll up her sleeves, despite severe pain in her arm and shoulder.

The Italian-born widow is more typical of the women Mr. Packman works with. "She had a very formal upbringing, as an Italian girl in an Italian family," he explains.

"Rosa, are you going to let me take off your sweater so I can work on your arm?" he asks.

Undaunted, Mr. Packman takes her arm -- woolen sleeve and all -- and proceeds to loosen the muscles. Then, he massages her fully clothed shoulders. "You don't want to take off your clothes? Fine. I go with it," he says.

Anyway, he says, young people today are too quick to bare all. In his private practice, "a lot of them don't hesitate, they take their whole nightie off," he says. "I tell them, 'I don't need all that.' "

The Last Frontier

But at Providence Rest, he says, modesty is the last frontier. The elderly, even patients with dementia, finds ways to make it clear they don't want to be touched in certain areas. And some patients simply refuse to have a massage by a man, so he has trained female assistants to handle those cases.

Still, there are a few patients who are willing to let their inhibitions, and perhaps an article of clothing, slip away. Among them is Helen Filardo, 89, who has been receiving regular treatment for soreness in her back, arms, legs, and even, lately, her hands.

As she arrives, she cheerfully announces: "I have to strip." So with some gentle assistance from Mr. Packman, she peels off her sweater and lets him massage her bare shoulder and back.

2008年3月9日 星期日

Wayne State University in Michigan has released findings from the largest study on the effects from mobile phone usage on health. They found is that there are other possible non-cancer related effects linked to mobile phones.

Radio frequencies emitted from mobile phones have now been associated with disrupting normal sleep patterns and inducing more frequent headaches.